The applicant, Michael LaMantia, MD, MPH is a geriatric physician and Assistant Professor of Medicine in the Division of General Internal Medicine and Geriatrics in the Department of Medicine at Indiana University. He additionally is a scientist at the Indiana University Center for Aging Research and Regenstrief Institute, Inc. The candidate's long-term career goal is to become a geriatrics clinical investigator who designs and implements systems of care to promote and improve the well-being of vulnerable older adults in the emergency department (ED) and other acute care environments. The research proposed in this application will provide information regarding the evaluation of delirium among older adults in the ED that is needed to improve the management of this serious condition. The candidate's immediate objectives are: (1) to acquire the research skills necessary to succeed in this program of research; (2) to gain the background needed to lead the design and implementation of systems that will provide better care to older adults in the acute care environment; (3) to conduct a mentored research program to evaluate the patient, provider, and workflow factors that influence the detection of delirium by emergency physicians (EPs); (4) to determine, by querying EPs the most effective cognitive strategies employed to recognize delirium; and (5) to extend the body of research regarding both short and long-term outcomes of patients whose delirium is either recognized or unrecognized in the ED . At the conclusion of this project, the candidate will apply data obtained from these studies to propose a logical and well-designed intervention to improve recognition and management of older adults with delirium in the ED in his first R01 submission. The career development plan proposes course work, a research project, and mentoring from a team of experienced investigators with expertise in a variety of relevant fields (health services research, medical sociology, emergency medicine, and delirium science) to provide synergistic advice on the accomplishment of the proposed projects. The applicant will benefit from a host of local resources available to support him in the completion of this project including the Indiana University School of Medicine and IU Center for Aging Research; the Regenstrief Institute and its extensive Regenstrief Medical Record System; as well as the clinical resources of the Indiana University Department of Emergency Medicine.